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  4. Secretary Kathleen Sebelius

Kathleen Sebelius
Secretary of Health and Human Services
157 Landon Lecture
Nov. 29, 2010


I want to start by thanking President Schulz for not only that nice introduction but for your leadership of this incredible university. I didn't have a chance to really work with President Schulz, he was chosen as I was leaving Kansas but I've certainly watched him in this capacity and he's doing a terrific job, and K State is not only important in the Manhattan community, it's one of the state's crown jewels, and it's a critically important university to our nation. And I'm really pleased also to be here today with lots of members of the Wildcat family; with the key members of the administration and faculty, with supports, advisers, and students, and I'm also delighted to be here at the home of the nation's best coaches, Bill Snyder and Frank Martin.

You know Coach Snyder and I had a chance to work together on lots of issues, as governor, most particularly finding more adults to mentor Kansas kids and he does a great job not only on the field but each and every day in communities throughout this state. And I haven't had a chance to get to personally know Frank Martin, but I've certainly watched him, and am one of his legions of fans, and I have to tell you watching that Duke game the other night, a few more free throws and a little mojo for Jake Pullen and K State can beat any team in the country, no question about it.

But what's really impressive about the coaches is they are both coaching kids for life skills and not just sports skills and that's what university coaching is all about. You know I'm pleased to be back here with all of you. In my new position in Washington I am really guided every day by the work we did here in Kansas to build a stronger, healthier, and more prosperous state every day of the year. It's great to be here in Manhattan; I have a real soft spot for Manhattan and for K State. I married a Wildcat, and that's what brought me to Kansas, so it will always be near and dear to my heart, and though I'm now on the East Coast, Manhattan to me always means Kansas and not New York.

So I know this is a terrific place to get a college education, but also, it's such an important engine for our state's economy, a steady source of innovation in so many areas, from engineering to agriculture. And I'm especially proud of the work we did and that K State was selected to be the site of a new state-of-the-art lab, one of only three in the world that will put our state at the forefront of animal health research, not in the country, but throughout the global community.

Now, our department, HHS, operates similar labs for human diseases through the Centers for Disease Control and through the National Institutes of Health, and I know how absolutely critical they are to the health and security of our nation. So I'm glad to see plans for this facility moving forward here in the heartland. And thank you so much for inviting me, as you can see I still have an array of purple in my closet and it's good to have a chance to wear it once again. But it's a huge honor to be invited here to give the Landon Lecture, to be here where so many leaders have stood before, in this great auditorium, and of course as President Schulz has already said, the first of those great leaders was Governor Alf Landon himself.

Now, Governor Landon had a truly remarkable life; he was a great success in the oil business, he fought in the First World War, he served as Governor of this state. He ran for president, and eventually became one of our country's greatest statesmen. Governor Landon was also fortunate enough to witness some amazing events in history: The invention of the automobile, the defeat of Fascism, the Civil Rights and Women's Rights Movements, technological leaps that put a man on the moon and gave us a personal computer. But I would argue that no area where our country has made more leaps during Governor Landon's lifetime than during the last century was our move forward in the health field.

Governor Landon was born in 1887, and at that point the average lifespan for an average American was to live to mid 40s, which was maybe only a dozen years longer than the average lifespan of the hunter-gatherers who were on these plains thousands of years ago. But in 1987, when Governor Landon passed away just after his hundredth birthday, the average lifespan of a U.S. citizen had risen to 75 years. That's a remarkable span. Diseases like Smallpox and Polio, which used to be every parent's greatest fear, were wiped out in this country. Conditions that had once been a death sentence became manageable. And the death rate for coronary heart disease had dropped more than 60 percent since World War II. The death rate for Stroke was 70 percent lower than it was at the beginning of that century.

And there are lots of reasons for those gains in health. Scientific breakthroughs like Penicillin played a role. So did public health breakthroughs like improved sanitation and clean water. Public policy breakthroughs also helped, like Medicare, which provided unprecedented security for half of the seniors, who prior to 1965 had no health insurance at all. So those gains in health really transformed our country. Because health is really about freedom. When we live longer, healthier lives we've got more time to do our jobs, more time to volunteer in our neighborhoods, to play with our children, to watch our grandchildren grow up.

But health is also the foundation of our national prosperity. Healthy adults are more productive workers. Healthy children are better students. Healthy families make greater contributions to their own communities. So when the health of a nation improves, we see the benefits each and every day in our lives. And today I want to talk about some of the steps I believe we can continue to take to make progress so that we can leave a healthier country for our children and our grandchildren.

The most significant piece of health legislation passed in the last 45 years is the Affordable Care Act, which was signed into law last March. It lays the framework for reorganizing health care and well as reorganizing our health insurance system. Now, for years we've had a health insurance market that was crumbling. Employers were dropping coverage, premiums were skyrocketing, consumers were getting more and more frustrated, and more Americans were shut out, priced out, or dropped out of the market altogether. Without health insurance, or with insufficient health insurance, too many Americans went without critical care, or saw their savings disappear in one accident or one family illness. And without legislation, the market would have continued to deteriorate over time.

So over the last eight months since the new law was signed, our department has been working closely with governors and lieutenant governors like Troy Fineley, who's here today, insurance commissioners like Sandy Preager across the country, as well as health care providers, and consumer groups, and employers to implement the first parts of this new law. And while we've got a long way to go, we already see signs of progress right here in Kansas. So in the last few months we've begun addressing one of the really unacceptable gaps in the health insurance system, the so-called doughnut hole for seniors for prescription drug coverage. About 19,000 seniors in Kansas have already gotten some help with that drug coverage with a $250 check mailed this year, and next year, they'll begin to see a 50 percent decrease in the price of those prescription drugs. Eventually that doughnut hole will be closed altogether.

We've also established an early retiree reinsurance program that helps employers maintain coverage for their early retirees. Now right now, a lot of folks are retired that aren't yet eligible for Medicare, they're not 65 yet, and they rely on their former employers for insurance coverage. But as health care costs rose, more and more employers ended that retiree coverage, which leaves folks in their early 60s with nowhere to go. And individual coverage for a 60-something can be very, very expensive. And so far 30 major Kansas employers and unions from Spirit Arrow Systems to Sprint Nextel have applied to be part of the program to keep their retiree coverage in place, and that helped stabilize a very fragile part of our market.

And with support from our department, Kansas had also set up a pre-existing condition insurance plan, where adults who had been shut out of the health insurance market because of pre-existing health conditions, can now get affordable coverage on their way to 2014. One Kansan who wrote me recently was typical; he and his wife run a business in Salina, and they bought health insurance year in, year out for their employees, because they thought it was the right thing to do and they wanted to keep the best employees in place. Then when they retired, they applied for individual coverage from the same company they'd been purchasing employee coverage from over the years, but because they had minor health conditions, they were denied coverage. And they wrote to me and said, we're worried we won't be able to find insurance coverage at all, but thanks to the Affordable Care Act, there are new options now for retirees like this couple.

We've created a new Patient Bill of Rights that establishes some long overdue consumer protections in the health insurance market, some new rules in areas that I saw year in and year out working as Insurance Commissioner. For example health insurance companies can no longer take away someone's insurance when they get sick, just because of an unintentional mistake in their paperwork. And last week we announced some new rules that companies will have to make sure that at least 80 cents of every premium dollar collected will be spent on health care and quality care issues, not on salaries, and marketing, and administrative costs. And there's one reform that's particularly important to students here today; now we know that young adults in their 20s have had very low rates of health insurance, and twice as likely to be uninsured as older Americans. Part of the reason is it's not always easy to get a job that offers health insurance right out of high school or college. I know that because when our sons graduated from college, neither had a job with benefits. Our older son was going back to Graduate School, not quite sure what our younger son was doing but let's just say it didn't come with health insurance.

But as part of the new law, young Americans who don't have insurance from their employers can stay on their parents' plans until their 26th birthday. So whether you're still looking for a job after graduation or going off to graduate school, or working for a small business or a not for profit that doesn't offer health insurance, you won't have to worry about health coverage. Now, these reforms are not going to fix every problem in our health insurance system overnight. In fact because we didn't want to disrupt the coverage that 180 million Americans already have, many of the important changes are phased in over time and don't take effect until 2014. But we're starting to fill some of the biggest gaps and end some of the worst abuses and give more control to all the people who felt like there was nothing they could do when their premiums went up 30 percent, or their claims were denied.

And as we go forward, I can tell you we're looking forward to working with all of our state partners to implement the law effectively and improve it along the way. But contrary to the impression you might have watching cable news, there's a lot more to health than health insurance, and a lot more progress being made today than just the focus on the new law. So what I'd like to do with you today is share six additional areas; reforms, investments, and technologies that I believe are essential to creating a healthier country. Now this list is not comprehensive, it's not all we're doing at HHS. But they help to create some of the useful examples of the kind of work that we can do together to keep America on track toward a healthier future. And along the way they might answer another question some of you might have which is, exactly what does the Department of Health and Human Services do?

Let me start with medical counter measure. Now here in Kansas, we do have a proud military tradition, and there's no doubt that a strong military is still the foundation of our national defense. But increasingly, the range of dangers we face is widening, to also include biological, chemical, nuclear, and radiological hazards. We don't know where the next public health crisis is going to come from. It could be, god forbid, a dirty bomb set off in a university lecture hall, it could be a naturally occurring super bug that resists all treatments. It could be a biological weapon we've never seen before, assembled from the building blocks of life by a terrorist in a lab. In order to respond effectively when the crisis comes, we need to have in place what are called medical countermeasures -- the vaccines, antivirals, diagnostics, and other drugs and equipment that often are our first and best defense against these threats. Now it's the same kind of response that the new Animal Health Lab here in K State will help to identify for animal crises, and we're responsible for it when it comes to human health.

The problem now is there's little incentive for the big drug companies, the pharma companies to produce medical countermeasures for conditions like Ebola virus or exposure to non-medical radiation, even though in the event of an outbreak or a nuclear explosion, those countermeasures are absolutely critical. So it's up to our department, working with the Federal Government, to figure out strategies to produce stockpiles of these important antivirals. After September 11th, the U.S. government came up with a plan to make up for the shortfall, but we still aren't as nimble and flexible as we need to be. So over the last two years we were charged by President Obama to conducting the first ever complete review of the Operation to Develop and Produce Medical Countermeasures. And we've identified a couple of key areas where we can strengthen our countermeasure pipeline; for example, one that we're exploring that is actually used right now in the defense community is launching a non-profit, venture capital firm providing strategic support to the small companies that have big ideas but can run out of capital before they can get that product to the market. The Defense Department has used this strategy very effectively in some new weapons development; again, not something that there's a big market for, but an important issue.

Another area's providing additional resources to the Food and Drug Administration, one of our agencies, and the National Institute of Health, another agency, making it easier for companies to produce countermeasures and navigate the regulatory system by creating clear regulatory pathways; analyzing, promising new discoveries on a much faster pace, and helping identify and solve the scientific problems as they occur. The goal is getting great ideas from the microscope to the marketplace in a much more timely and efficient manner. And as all the athletes here know, how well you perform in the spotlight depends on how well you practice when no one's watching. So the same is true with our response to public health crises. How well we prepare now will determine how successfully we can respond when the next crisis comes, and we know, unfortunately, that we will have a future crisis. So the review gives us a road map for improving our preparedness and we're working now with Congress to fill those gaps, and we need to follow that road map to a safer and more secure future.

Cancer is another big issue on our horizon. We need to provide some additional focus on this dread disease. One of the focuses that we've seen since the days that Governor Landon was born is that we have to worry about new health threats. Many cancers don't become deadly until after someone's 60th birthday, so it wasn't a big issue 100 years ago when the average lifespan was shorter than that, but now what we see is more and more people, and half the men, and a third of the women in the United States will develop cancer in their lifetime. That's a lot of our population. And the good news is that as cancer is becoming a more frequently seen disease, breakthroughs in science are giving us better weapons for fighting those cancers. For years the approach to treating cancer was similar, as the scientists tell me, to carpet bombing, where you attacked with radiation or chemotherapy all of the dangerous cancer cells but you also killed a lot of good cells along with it and you just hoped you weren't on balance killing more good cells than the bad. But thanks to the progress scientists have made cracking the genetic code, we now have the possibility of developing more effective targeted therapies. For example, we've got a new drug that NIHS is testing right now called Herceptrin that can cut the risk of early breast cancer occurrence in half for patients whose tumors have a certain genetic marker, and it shows incredible signs of promise.

But to speed the development of the new treatments, we've created what we call a Cancer Genome Atlas at the National Institutes of Health, uses funds from the Recovery Act, and we're expanding a comprehensive database of the changes associated with 20 major tumor types. It would unleash a new generation of cancer treatments targeted at an individual, specific tumor. And we've just begun to travel down these research avenues, but we need to keep pushing forward so the continued investment in that scientific research is so essential. Just since I began this speech this morning, 20 more Americans have died of cancer. And if we can speed up the development of the next generation of targeted therapies, we could strike a huge blow against a disease that now kills more Americans than any other disease beyond heart disease.

To be a healthier country we need to cures and treatments, that's for sure, so we've talked about countermeasures and we've talked about cancer, but we also absolutely have to improve the way we deliver health care. For example, every year tens of thousands of Americans die of what are referred to as health care associated infections. More than die from homicides and car accidents combined. Now these are the infections that don't take you to the hospital, these are the infections that kill or injure you once you are in the hospital. And they are one of the top 10 killers of Americans today. Doctors at Johns Hopkins have developed an incredibly effective tool for saving lives in hospitals and in nursing homes and in health care centers. It doesn't take a huge investment of new equipment, it doesn't take new training, it doesn't take new personnel; it's really a checklist of protocols and procedures that have to be followed in every room, every time, by every provider. Basic steps like washing hands with soap to wearing a sterile mask, doing it each and every time, in contact with patients. Now it's hard to imagine that such a simple procedure could make a big difference, but when it was tested in Michigan hospitals, and used by doctors who insert catheters into a major vein, the results were incredible. In 18 months, infection rates were down 66 percent, 1500 lives were saved, and costs went down by $200 million, just with a small group of hospitals. And if you hear those numbers you must think every operating room in America uses a checklist, but unfortunately, that's not the case.

The truth is that innovations travel way too slowly in our health care system. Recent research shows that it would take 17 years -- that's one, seven -- 17 years from the discovery of an effective treatment or protocol to be incorporated into routine patient care. By comparison for many of you today it takes seconds for your friends in California to learn on Facebook that you're in a new relationship or that it's complicated.

But it can take years for a hospital in California to learn how a hospital in Kansas is improving care. So one of the best ways we can become a healthier country is to speed up the rate in which life saving treatments and innovations like the checklist are adopted universally. And it starts with creating incentives that actually reward better care. So if you look at the new health care law, you'll see that there's provision after provision that create incentives for doctors and hospitals to deliver higher quality care and actually be reimbursed for that care. And to understand the potential of those changes, just think about the Michigan example. One quality measure, one kind of procedure, saved 1500 lives in 18 months, and multiply that by 50 states for just that one procedure. We know that we can do a better job delivering health care and we can start to see the difference that these changes can make.

Another area where the health industry is frankly way behind other industries in America is using technology. Another step that is going to help us dramatically improve the quality of health care is adopting electronic medical records for all hospitals and all doctors. Now in industry after industry we've seen technology bring down costs and improve the customer experience. Imagine going back to the days when you were at a grocery store and somebody was hand adding all the hand written price tags, or waiting for the bank to open so you could cash your check and actually have cash for the day. We cannot imagine those systems going backwards but health care is different, and it shouldn't be. In fact we've already seen the power of electronic health records across the country; cutting health care costs, reducing paperwork, improving outcomes, and giving patients actually more access to their own health information.

Four months ago I was in Cincinnati and visited the Neo-Natal ward of Cincinnati Children's Hospital; it does some of the most complicated procedures in the country on these tiny infants. They've gone 1,000 days with a serious safety incident, a record they directly credited to electronic health records because every provider in touch with every baby had to code in the medicine, code in the procedure, it was checked on a regular basis and actually, they were denied access if they were put in the wrong code at the wrong time.

A big part of my job now is travelling around the country talking to doctors and nurses and I haven't met a single service provider who uses a high quality electronic health record and says god I wish I could go back to the days when we had those great paper files, it's really, you know, the best way to practice. And yet here's where we are in this country. Two in 10 doctors, and one in 10 hospitals even use a basic electronic medical system today. How many of you have gone to the school clinic, or doctor's office and handed the infamous clipboard where you once again record all of your health data, which somebody had on file somewhere but it has not been transferred. And there's some reasons for this; it's not easy to learn a new technology, especially if you're a doctor in a small practice that doesn't have an IT department. And sometimes if you're a doctor in a small practice and you're somewhere in rural Kansas, you are the IT department. So there's a challenge of being able to share information with other providers securely, even if they have a different system and if you can't get information from your patients other doctors, electronic records lose a lot of their value. And there's the fact that these systems can be expensive, even if they pay off in the long run.

So what's happened in the last two years is an unprecedented effort to remove some of those barriers, to move medicine into the technological age. We've created health IT Regional Extension Centers across the country modeled exactly after the Agriculture Extension Centers where their teams ready to come and visit with small providers and small hospitals to be the boots on the ground to provide the technological expertise. We know how effective that is when teams from the Farm Extension Service come to a farmer's land, look at the seeds they're using, look at the dirt, figure out what's working and what's not. And we want to apply that same kinds of hands on technology to the medical field. The health IT Centers actually provide that kind of hands-on support and one of them is going to be located right down the road in Topeka.

We're also providing grants to help states create a framework, a statewide framework for docs and hospitals to exchange information with full protection on patient privacy. The good news is here in Kansas we had done a lot of work in this area so we're well ahead of many states in the country and we're ready to go. We're providing bonus payments for hospitals and doctors to adopt electronic health records and we're helping them to use those record keepers for improving patient care. Now together, these investments are going to knock down many of the obstacles standing in the way of building a 21st Century health care system, using technology to improve results and lower costs just like every other enterprise. The result is that doctors are going to have more time to spend with their patients, more tools to do their job of patient care, more ability to coordinate that patient care. And America actually has an opportunity to be a world leader in one of the growing industries of the future; the technology of health information.

We know, again, that health and wellness is important, it's an important building block. If we want a healthier country, we can't just focus on what happens in a doctor's office or when you get to the hospital. We also have to pay attention to the air we breathe, and the food we eat, and the lifestyles we live. Now right now, in America, we have an obesity epidemic. Two in three adults in America and one in three of our children are overweight or obese. This isn't a fashion crisis, it is a very serious health crisis. Obesity brings with it a far higher risk of heart disease, of stroke, of certain cancers. And it's the biggest predictor of diabetes, which can have crippling effects throughout a life. And that's why the administration has launched a really broad agenda to help Americans make healthier choices. From the First Lady's Let's Move Campaign, to the investments we're making in some of the most promising community's strategies for reducing obesity, like bringing supermarkets to food deserts. And for a farm economy like Kansas, linking local grocers to purchasers can not only improve health but also help that economy in the first place.

One of the biggest obstacles we know to eating healthier choices is knowing really what foods are the healthiest. Now, most people know that fresh fruits and vegetables are better than a cheeseburger and French fries. It might not taste better, but they are better for you. But it's hard to guess that a tuna melt from a fast food chain has more fat than a stick of butter if you would just sit down and eat that at your kitchen table. Or to pick out the healthiest cereal from an array of 50 choices. While you could go to a food chain's website, or try to read the tiny nutrition facts on the back of packages, most people don't' have the time and frankly they don't have the interest. But we know that giving consumers some additional tools and some information about the foods they eat can be helpful. So part of the Affordable Care Act will have chain restaurants begin to display calories for the different offerings on their menu, so people actually get a chance to see what choice they're making. We're working with food manufacturers and grocers to put easy to read, easy to identify labeling on the front of packages, so that when you go to the grocery store after a long day of studying or work you can actually figure out much more easily what is the healthier option.

The truth is that most folks really want to eat healthier diets, maybe not in Aggieville at 3:00 a.m., but most of the time you want to eat a healthier diet.

But the challenge is to make a healthy choice more convenient, more affordable, more easily accessible, and that's really what we're trying to do.

Finally I want to spend a minute just talking about food safety. At the same time we're working on keeping Americans healthier, we need to put a new focus on keeping our food safe, an area that, as President Schulz says, is one of the hallmarks here at Kansas State University. Every year millions of Americans suffer from food-borne illness. Hundreds of thousands are hospitalized, and thousands of people die. And the way our food safety system works in America today doesn't make a lot of sense. Local officials start to see an uptick in people getting sick and they might suspect a food-borne illness. They then notify our regional folks at the Center for Disease Control that something is going on, who then send investigators to try and pinpoint where the outbreak is and eventually the Food and Drug Administration is notified; they investigate the source and they begin to warn the country about the food of concern. Still the Food and Drug Administration has no recall powers of its own, they can send a warning but they can't mandatorily get the food off shelves, that's a voluntary activity.

In other word we're still working backwards, we chase the outbreaks after they occur and we're trying, always scrambling to catch up with what's making people sick. Not only does it cause a lot of anxiety and concern for consumers who are shopping and trying to figure out what's going on, it also causes major disruptions and economic losses for farmers and producers. Every time someone gets a tainted food product, and people get sick, the entire industry suffers. In farm states like Kansas we understand the importance of a safe and secure food supply better than anyone, and we've seen firsthand how producers can take a huge economic loss if folks are scared of buying a product, even if there's no scientific evidence behind it. So the problem is that we've monitoring a 21st Century food system with 20th Century tools.

Today nearly half of our fruit and nearly three quarter of our seafood comes from overseas, whether it's tropical fruit from Mexico, or Chilean Sea Bass that you enjoy in a restaurant. But many of the importers don't have the same strict food safety standards that we have here in the United States. And as the food system has evolved, our methods for monitoring what's being served in people's kitchens has not. The last significant food safety related changes, the Food, Drug and Cosmetic Act, took place in the late '30s, before many of the student's grandparents were born.

And so one of the biggest challenges as Secretary of Health and Human Services had been working in close collaboration with Agriculture Secretary Tom Vilsack, former governor from another farm state of Iowa, to build a 21st Century food safety system. It's been a top priority of the president, and we want to move forward with a system where we can prevent outbreaks in the first place, or catch them early much closer to their source, and give people the information that they need at every step along the way. There's legislation pending right now in the United States Senate that would be the biggest update to the food safety effort in decades, and we hope it will pass soon so we can start reducing these preventable deaths.

So I've just talked about six areas, steps we can take to become a healthier country: Strengthening our medical countermeasures and pipeline, pursing targeted therapies against cancer, reducing health care associated infections, switching to electronic health records, putting better nutritional information in people's hands, and building a 21st Century food safety system. Now they're all top priorities for our work, and areas where we're either currently making or plan to make significant progress. They're also goals that most Americans can support. Making sure we have an adequate supply of vaccine and antivirals for the next public health crisis isn't a democratic strategy or republican strategy, it's an American strategy. The new food strategy has strong support from both parties. We can all get behind saving lives and lowering costs by reducing hospital errors. And yet you rarely hear about those stories in the newspaper. And that's not surprising -- there'll always be more coverage of political battles than on areas where there's a lot of agreement. A plane crash that kills 200 people will always be a more dramatic story than a hospital checklist that saves 2,000 lives. But it's important that we don't lose sight of these opportunities, because it's these steps, and steps like them, that will determine whether we continue to make the same kind of gains in health care that we have made over the last century.

We should never fall into the trap of becoming convinced that progress is guaranteed. Recently, there's some pretty dire news on the horizon. Experts have said that we are raising the first generation of American children in 200 years to have shorter lifespan than their parents. And after the enormous gains we've made in health in the last century, our momentum is in danger of slowing to a halt, and even reversing. But it doesn't have to. If we can work together on the areas we agree on, compromise in the areas we don't, and make health a top national priority, I'm confident that the students here today will be able to look back at the end of their lifetimes, as did Governor Landon at the end of his, and know that they're leaving their children and grandchildren a stronger, healthier, and more prosperous America. Thank you so much for having me here today.



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